Objective To compare the perfusion pressure between cardiopulmonary bypass (CPB) through improved intubations of femoral artery-vein and routine identical flow on organic perfusion such as brain, lung, liver, kidney, intestines, etc.. Methods Twenty dogs with body weight from 10-15kg were randomly divided into two groups: thoracoscope group(n=10): CPB was set up by the right femoral artery-vein for completely video assisted cardiac operations; routine thoracotomy group(n=10): CPB was set up by the aorta-caval vein. The perfusion pressure of innominate artery, left common carotid artery, superior mesenteric artery, renal artery, homonymic and opposite side popliteal artery and the pressure of concomitant vein were measured at the following time points: instantly after induction of anesthesia (T1) , before aortic clamping (T2) , fifteen minutes after aortic clamping (T3) , fifteen minutes after aortic opening (T4) , twenty minutes after stop (T5) . The venous blood samples were collected at the preceding time points and venous oxygen saturation (SvO2) were measured. Results There were no significant difference between both groups in arterial perfusion pressure, besides perfusion pressure of homonymic popliteal artery in thoracoscope group was lower than that in routine thoracotomy group (Plt;0. 01) . Before aortic clamping, fifteen minutes after aortic clamping and fifteen minutes after aortic opening, venous pressure of renal vein, superior mesenteric vein, homonymic and opposite side popliteal vein in thoracoscope group were higher than those in routine thoracotomy group (Plt;0. 05) . SvO2 of renal vein, superior mesenteric vein, homonymic and opposite side popliteal vein in thoracoscope group were lower than those in routine thoracotomy group (Plt;0. 05) . Conclusion The improved femoral CPB has a similar perfusion pressure with routine CPB and a higher vein pressure than routine CPB below inferior vena cava after aortic intubations. So this experiment provides theoretical evidence for the organic protection of infants’ thoracoscopic extracorporeal circulation.
Objective To summarize the revascularization method of infective femoral false aneurysm caused by drug injection. Methods Between November 2003 and May 2009, 84 patients with infective femoral false aneurysm caused by drug injection were treated, and the cl inical data were analysed retrospectively. There were 67 males and 17 females with anaverage age of 34.6 years (range, 19-51 years). The average duration of drug injection was 2.7 years (range, 1-11 years). In 13 cases, the defect of femoral artery was 3-10 cm; defect ranged from 1.0 cm × 0.3 cm to 3.0 cm × 0.7 cm in the others. The surgical treatment included bypass using synthetic grafts in 5 cases, great saphenous veins transplantation in 29 cases, repair of femoral artery in 24 cases, and l igation of femoral artery in 26 cases. Results Two cases died of intraoperative pulmonary embol ism. Eight cases had postoperative wound infection, which was cured after changing dressings. Incisions healed by first intention in the other paitents. A total of 82 cases were followed up 12-36 months (mean, 17.3 months). In 56 patients undergoing artery reconstruction or repair, dorsal pedis artery pulse was significantly improved, and no distal osteofascial compartment syndrome occurred. In 26 patients undergoing femoral artery l igation, angiography at 1 week after operation showed abundant collateral circulation from ipsilateral internal il iac artery, superior gluteal artery or contralateral internal il iac artery. Three cases had postoperative intermittent claudication which was improved after symptomatic treatment. Conclusion Infective femoral false aneurysm caused by drug injection should be treated surgerically as early as possible, and effective treatments include debridement, drainage, defect repair or bypass with synthetic graft or great saphenous vein from homonymy external il iac artery to superficial femoral artery. Ligation of femoral artery is an option in patients with serious infection when revascularization is impossible.
OBJECTIVE: To evaluate the effect of low-dose aspirin on the deposition of platelet at the anastomotic site and the function of coagulation system in order to provide experimental data for clinical use. METHODS: (1) Twenty-eight SD rats were divided into experimental group (n = 21) and control group (n = 7), aspirin were administered through a catheter placed in the femoral vein in dose of 4 mg/kg in the experimental group and the same dose of normal saline in the control group. The experimental group was subdivided into 3 groups, with 7 rats in each group, according to survival time of 24, 48 and 72 hours after dose. Samples of 4 ml blood were taken by heart puncture from each rat to investigate the maximal platelet aggregation rate(MAR), prothrombin time(PT) and kaolin partial thromboplastin time(KPTT). (2) Sixteen New Zealand White rabbits were divided into experimental and control group, 8 rabbits in each group. Drugs were given in the same way. Forty-eight hours later, the bilateral femoral arteries of each rabbit were exposed and arteries between inguinal ligament and the origin of the superficial epigastric arteries were transected and end-to-end anastomosis was completed with interrupted suturing technique. Fifteen and 120 minutes after the recovery of blood flow, the left and the right vessels containing anastomotic sites were harvested respectively and treated with 125I-labeled anti-GP IIb/III a antibody (SZ-21) using radioimmunobinding method. The radioactivities of the anastomosed vessels were measured. RESULTS: The KPTT in the experimental group was longer than that of the control group at 24- and 48-hour group, the mean percentages of increase were 42.56% and 35.33% respectively, and there were very significant differences between the experimental and control group in 24-hour group (P lt; 0.001). The PT value in experimental group was longer than that of the control group, but there was no significant difference (P gt; 0.05), and the maximal aggregation rate of platelet in the experimental group was significantly lower than that of the control group after 72 hours (P lt; 0.001). The radioactivity of the anastomosed arteries in the experimental group were significantly higher than that of the control group (P lt; 0.001) at 15 minutes after the recovery of blood flow, the mean percentage of increase was 110%. CONCLUSION: Low-dose aspirin can significantly affect the function of the intrinsic coagulation system, prevent the aggregation of platelets, but no effect on the function of the extrinsic coagulation system. On the other hand, it can also increase the deposition of platelet on the anastomotic sites after end-to-end anastomosis, especially in the early stage when it is intravenously injected, but it is b enough to cause thrombosis at the anastomotic sites. The effects of low dose aspirin on the coagulation system are inconsistent with its local effects on anastomotic sites.
OBJECTIVE: To explore the relationship between the properties of compliance and the change of structure of components in anastomosed arteries. METHODS: The arterial pressure and diameter of femoral arteries of dogs were measured in vivo before and after arterial anastomosis in different time intervals to deduce the arterial compliance. The anastomosed arteries were removed and evaluated through light microscopic examination and various staining methods, the relative contents of elastin, collagen and smooth muscles were measured through image analysis system. RESULTS: The compliance of arteries was gradually decreased after anastomosis with peak-time on the 14th day. The content of elastin at different time had no significant difference, while the content of collagen increased gradually, the ratio of them was increased. CONCLUSION: The property of compliance of anastomosed arteries is closely related to the contents of the structural components.
Objective To evaluate surgical treatment of infected femoral artery pseudoaneurysm. Methods The data on surgical treatment of 45 patients with infected femoral artery pseudoaneurysm admitted from January 2003 to June 2008 were analyzed retrospectively. Fourty-three patients underwent operative treatment including excision of infected femoral artery pseudoaneurysm, exhaustive debridement and bypass graft with vascular prosthesis. Two patients were unavoidable to undergo removing of infected femoral artery pseudoaneurysm and ligating the proximal and distal artery of pseudoaneurysm because of severe infection and large volume. Results The patients were followed up from 3 to 12 months (mean 7.82 months). The limbs of all the patients underwent bypass graft with vascular prosthesis were salvaged successfully, patients of which had secondary wound healing and had not intermittent lameness. One of two patients performed ligation of artery was salvaged successfully but had severe intermittent lameness, another patient underwent high amputation above knee because of ischemic gangrene. Conclusion For infected femoral artery pseudoaneurysm, the operative treatment including excision of infected femoral artery pseudoaneurysm, exhaustive debridement and bypass graft with vascular prosthesis is effective and safe.
ObjectiveTo investigate the clinical efficacy of sarpogrelate hydrochloride in preventing restenosis after femoral artery stent implantation. MethodsTwo hundreds and fifty-one cases of ischemic disease of lower extremity (286 affected limbs in total) who got treatment in our hospital were collected, and were divided into prevention group(125 cases with 146 affected limbs) and control group(126 cases with 140 affected limbs) according kinds of medicine. At the basement of medicine in control group, cases of prevention group got treatment of sarpogrelate hydrochloride in addition. Comparison of related indexed was performed by SPSS 17.0 software. ResultsCompared with before treatment in prevention group, only foot skin ulcer and gangrene score decreased(P<0.05), and there were no significant difference on other indexes included visual anafogue scales(VAS), intermittent claudication distance score, ankle brachial index (ABI), and vascular stenosis score(P>0.05). But in control group, compared with before treatment, foot skin ulcer and gangrene score and ABI value decreased(P<0.05), the VAS score, intermittent claudication distance score, and vascular stenosis score increased(P<0.05). There were significant difference on the difference between after treatment and before treatment of all 5 indexes(P<0.05), that the changed value of foot skin ulcer and gangrene score was higher in prevention group, but lower on other 4 indexes. There were no untoward effect happened during treatment. ConclusionClinical effect of sarpogrelate hydrochloride in the prevention of restenosis of the femoral artery after stent implantation was significantly, and it can keep related indexes stable.
ObjectiveTo investigate the advantages of magnetic compressive anastomosis (MCA) for non-suture femoral artery anastomosis. MethodsTwelve adult health mongrel dogs,weighing (16.5±3.6) kg,were selected for in situ end-to-end anastomosis of the femoral artery.One side of the femoral artery was anastomosised with MCA (group A) and the other side of the femoral artery was anastomosised by hand-suturing (group B).The anastomosis time,complications,and vascular bursting pressure were recorded.Gross observation,histological staining (HE and Masson),and scanning electron microscopy observation were performed at 2,4,12,and 24 weeks postoperatively. ResultsThe anastomosis time in group A [(3.89±1.16) minutes] was significantly shorter than that in group B [(14.16±3.72) minutes] (t=14.226,P=0.000).The complication rate of group A (0) was significantly lower than that of group B (75%)(P=0.000).At immediate,4 and 12 weeks after operation,the vascular bursting pressure of anastomosis site in group A was more than 280 mm Hg (1 mm Hg=0.133 kPa),and was (140.11±15.23),(180.31±24.55),and more than 280 mm Hg in group B,showing significant differences at immediate and 4 weeks (P<0.05),but no significant difference at 12 weeks (P>0.05).In group A at 4 weeks,good intima contact,smooth endothelium,and regular arrangement of endothelial cells were observed;at 12 weeks,chronic inflammation was present,with a few lymphocytes infiltration;and at 24 weeks,inflammation significantly decreased.But in group B,obvious suture foreign body and scar formation were observed,which led to uneven surface with lumen incomplete intima,and irregular endothelial cells in arrangement disorder. ConclusionCompared with traditional hand-suturing,the MCA has the advantages of shorter operation time,higher patency rate,less complication,and better healing at the anastomotic site.Non-suture anastomosis of the femoral artery by MCA can achieve reliable results.
ObjectiveTo systematically assess the efficacy and safety of percutaneous access and surgical cutdown in transfemoral transcatheter aortic valve implantation (TF-TAVI).MethodsWe searched databases including the Cochrane Library, PubMed, OVID, Embase, China National Knowledge Internet and Wanfang Database to collect randomized or non-randomized controlled trials comparing percutaneous access (PC group, the trial/exposure group) with surgical cutdown (SC group, the control group) in TF-TAVI between January 2002 and October 2017. The quality evaluation and data extraction were carried out by 2 reviewers independently. The Meta-analysis was performed using RevMan 5.3.5 software.ResultsA total of 11 literatures involving 4 893 aortic valve stenosis patients treated by TF-TAVI (2 877 patients in PC group and 2 016 patients in SC group) were included in this Meta-analysis. There was no significant difference between PC and SC group in terms of major vascular complications [odds ratio (OR)=0.86, 95% confidence interval (CI) (0.70, 1.06), P=0.17], minor vascular complications [OR=1.43, 95%CI (0.87, 2.37), P=0.16], major bleeding [OR=1.02, 95%CI (0.55, 1.90), P=0.94], minor bleeding [OR=0.90, 95%CI (0.51, 1.61), P=0.73] and all-cause mortality within 30 days [OR=1.03, 95%CI (0.76, 1.40), P=0.85]. As for the length of stay after TAVI, there was significant difference between the two groups [standard mean difference=–0.32, 95%CI (–0.52, –0.12), P=0.002].ConclusionPercutaneous access is as effective and safe as surgical cutdown in TF-TAVI, meanwhile leading to shorter length of stay after TAVI.